For every 1,000 live births in India, 74 children die before they are five years old, according to the latest National Family Health Survey (NFHS-III) data. While these statistics illustrate the steady reduction in under-five deaths in the last decade (down from 109 in 1992-93), they also reveal the gravity of the problem and the pressing need to tackle it effectively. Neonatal mortality, i.e., death within the first 28 days of being born, makes up more than half of the under-five deaths in the country. According to the NFHS-III Survey, the infant mortality rate for families from the lowest wealth quintile is 70.4 percent to the 29.2 percent for those from the highest wealth quintile.
The Indian government has launched a series of policies and schemes to address the undesirable situation of maternal and child health, including the National Rural Health Mission (NRHM) and the soon-to-be-launched National Urban Health Mission (NUHM). The government has also created a program called the Janani Suraksha Yojana, which incentivizes women to deliver their babies in hospitals instead of at home. The aim of these schemes is to improve the availability of and access to quality health care for everyone but especially for the most vulnerable sections of society: the poor, women, and children. These groups fare worst on the Human Development Index F95zone .
For instance, under the NRHM, the government has sanctioned Accredited Social Health Activists (ASHAs) to bring communities and health services closer, and Village Health and Sanitation Committees (VHSCs) to liaise with district authorities and ensure health care facilities are accessible and needs are being met. Both these groups are community-based: ASHAs are volunteers (often housewives) from the community, and VHSCs consist of elected community members.
But what happens if people don’t volunteer, or if VHSC meetings aren’t held regularly? In many villages, where concerns for the basics of survival dominate, it is easy for issues of maternal and child health care to take a backseat. What’s more, in a country of India’s size, supply gaps remain and there is confusion among local communities regarding the details and applicability of government schemes. Often, this confusion is caused by inadequate communication or a gap between communities and local government agencies. As a result, people often fail to utilize the available services and the most vulnerable people, who have the greatest health needs, find it hardest to access health services.
There is an important role here for the voluntary and nonprofit sector. These organizations can serve as a bridge between the government and communities, helping to synergize the efforts of both in saving the lives of mothers and children.
One such organization is PATH, a global not-for-profit body that is running a five-year program in India called Sure Start. The project works with rural communities in Uttar Pradesh and among settlements of marginalized people in Maharashtra’s sprawling cities.
Projects such as these work in tandem with the Indian government’s efforts and develop community-level systems for improved services. For instance, VHSCs often fall short of their full potential. Sure Start has been instrumental in activating the committees and ensuring that members hold regular meetings. Through the committees, communities have been able to demand improved health care and other services from district authorities. For example, payments under the Janani Suraksha Yojana have increased.
Dr. Rana Pratap can testify to this improvement. As a government worker at a primary health center (PHC) in the Hardoi district in Uttar Pradesh, Dr. Pratap has been providing health services to socially and economically disadvantaged communities for many years. Despite the numerous government plans, Dr. Pratap had often felt that his patients missed out on some services.
Lately, he has noticed a remarkable change. For one thing, he has become busier. “Health plans and reviews have to be effectively conducted at the village level by the communities themselves. I now have to attend community meetings and participate in reviews. Many times,” he adds, “I have to explain why the PHC is unable to deliver certain services.” Dr. Pratap has also noticed an increased demand for his services with the growing awareness of maternal and child health care issues in his community.